A prospective, single-arm, multicentre clinical evaluation of a new localisation technique using non-radioactive Magseeds for surgery of clinically occult breast lesions.

AIM: To evaluate the safety, usefulness, and outcome of Magseed localisation for surgery of non-palpable breast lesions in a non-experimental setting. MATERIALS AND METHODS: An audit was undertaken of a prospectively maintained database of patients who had undergone breast surgery under Magseed guidance in two high-volume institutions in the UK. Patients were selected for Magseed localisation depending on service convenience. Wire localisations were used in other patients in accordance with previous normal practice. One hundred and thirty-nine Magseed localisaton procedures were performed between September 2017 and March 2019. Data were collected on age, body mass index, size, bra cup size, weight of specimen, surgery, histology, re-excision rate, and time and mode of insertion of seeds. RESULTS: A total of 137 patients had Magseed localisation with a total of 139 seeds. Sixteen patients had a diagnostic procedure and 121 had therapeutic surgery. The distribution of procedures were similar between the two institutes (n=63 and n=74). Mean age was 60 (range 28-81) years. The majority of seeds were placed under ultrasound guidance (n=112) and 25 lesions were targeted under stereo guidance. Mean size of the lesions was 15.2 (range 1-85) mm. The mean weight of the specimen was 75.5 (range 2-1,900) g. The mean body mass index was 30.56 (range 18.1-48.3). All Magseeds and index lesions were retrieved. The re-excision rate for patients who underwent therapeutic surgery was 14.8% (n=18). CONCLUSION: The Magseed localisation technique of non-palpable breast lesions is a safe, easy procedure, and comes with the advantage of better utilisation of theatre and radiology resources. The re-excision rate in this series is lower than the national average.

Unhealthy environments, unhealthy consequences: Experienced homonegativity and HIV infection risk among young men who have sex with men.

Unfavourable social environments can negatively affect the health of gay, bisexual, and other men who have sex with men (MSM). We described how experienced homonegativity - negative perceptions and treatment that MSM encounter due to their sexual orientations - can increase HIV vulnerability among young MSM. Participants (n = 44) were young MSM diagnosed with HIV infection during January 2006-June 2009. All participants completed questionnaires that assessed experienced homonegativity and related factors (e.g. internalised homonegativity). We focus this analysis on qualitative interviews in which a subset of participants (n = 28) described factors that they perceived to have placed them at risk for HIV infection. Inductive content analysis identified themes within qualitative interviews, and we determined the prevalence of homonegativity and related factors using questionnaires. In qualitative interviews, participants reported that young MSM commonly experienced homonegativity. They described how homonegativity generated internalised homonegativity, HIV stigma, silence around homosexuality, and forced housing displacement. These factors could promote HIV risk. Homonegative experiences were more common among young Black (vs. non-Black) MSM who completed questionnaires. Results illustrate multiple pathways through which experienced homonegativity may increase HIV vulnerability among young MSM. Interventions that target homonegativity might help to reduce the burden of HIV within this population.

HIV testing among sexually active Hispanic/Latino MSM in Miami-Dade County and New York City: opportunities for increasing acceptance and frequency of testing.

HIV testing behavior is important in understanding the high rates of undiagnosed infection among Hispanic/Latino men who have sex with men (MSM). Correlates of repeat/recent testing (within the past year and ≥5 tests during lifetime) and test avoidance (never or >5 years earlier) were examined among 608 sexually active Hispanic/Latino MSM (Miami-Dade County and New York City). Those who reported repeat/recent testing were more likely to have incomes over $30,000, speak English predominately, and have visited and disclosed same-sex behavior to a health care provider (HCP) in the past year. Those who were classified as test avoiders were less likely to have incomes over $10,000 and to have seen an HCP in the past year. The main reason for not testing (in both groups) was fear of HIV positivity; however, twice as many test avoiders considered this their main reason, and more test avoiders had confidentiality concerns. Results suggest that messages to encourage testing among Hispanic/Latino MSM may be most effective if past testing patterns and reasons for not testing are considered. HCPs can play an important role by consistently offering HIV tests to MSM and tailoring messages based on prior testing histories.

Opportunities and challenges of next-generation DNA sequencing for breast units.

BACKGROUND: The aim of this review is to introduce the topic of next-generation DNA sequencing, a new technology that is being introduced into clinical practice, and to explain the potential impact for breast cancer surgeons and the wider breast cancer multidisciplinary team. METHODS: The PubMed database was used to identify relevant studies relating to breast cancer genetics. This evidence was then used to provide context and background information to demonstrate how next-generation sequencing (NGS) might change breast cancer practice. RESULTS: With NGS, breast cancer clinicians will know whether their patients carry high-risk mutations in genes, such as BRCA1 or BRCA2, before the start of treatment. This could alter treatment decisions; for instance, more women might opt for mastectomy instead of breast-conserving surgery, or for bilateral rather than unilateral surgery. CONCLUSION: The introduction of NGS will have a significant impact on breast cancer services in the near future. Speed of testing will improve in regions of the world where NGS is adopted in place of conventional sequencing, and, as costs decrease, genetic testing will also become accessible and realistic in less well funded health economies. This will create opportunities to improve patient treatment and challenges for the breast cancer multidisciplinary team.

Diverticular disease in younger patients--is it clinically more complicated and related to obesity?

AIM: The aims of this systematic review were to determine the presentations of diverticular disease in patients under 40 years of age and to assess whether obesity is an important factor. METHOD: The PubMed and EMBASE databases and the Cochrane Library were searched to identify all original articles published between 1990 and 2011 on diverticular disease severity in obese patients (body mass index of ≥ 30 kg/m(2) ) under 40 years of age. RESULTS: Twenty-three clinical case series (two of which were prospective) were identified plus two large aetiological population-based studies. These reported that young patients with diverticular disease were presenting more frequently, that diverticular disease in this age group was less likely to be complicated but that emergency operation rates were higher. The majority (63.1-96.5%) of patients under 40 years of age with diverticular disease were obese. CONCLUSION: The studies suggest that in the young, obese patient with lower abdominal pain, diverticulitis and appendicitis are included in the differential diagnosis. CT and/or laparoscopy should be considered where the diagnosis is in doubt.

Unity in diversity: results of a randomized clinical culturally tailored pilot HIV prevention intervention trial in Baltimore, Maryland, for African American men who have sex with men.

Unity in Diversity was a randomized controlled trial of a culturally tailored HIV prevention intervention for African American men who have sex with men. The intervention condition was six group-based sessions and one individual session. The control condition was a single-session HIV prevention review. Participants were aged 18 years or older, identified as African American/Black race, reported having at least two sex partners in the prior 90 days (at least one of whom must be a male partner), unprotected anal sex with male partner in the prior 90 days, and willing to test for HIV. Retention exceeded 95% at 3-month follow-up. Results of multivariate logistic regression analysis adjusting for baseline risk, HIV status, and health insurance indicate intervention efficacy in decreasing the number of male sex partners and marginal effects on condom use with male partners and HIV-negative/unknown partners. Specifically, intervention condition was associated with increased odds of zero male sex partners (adjusted odds ratio [AOR] = 3.03, 95% confidence interval [CI] = 1.26-7.28), condom use with male partners (AOR = 2.64, 95% CI = 0.95-7.36), and HIV-negative/unknown status partners (AOR = 3.19, 95% CI = 0.98-10.38) at follow-up. These results contribute to the limited number of culturally appropriate models of HIV prevention intervention that are urgently needed for African American men who have sex with men to address their persistently high rates of HIV.

Sexual risk behaviors among HIV-positive black men who have sex with women, with men, or with men and women: implications for intervention development.

OBJECTIVES: We compared demographics and sexual and drug risk behaviors among HIV-positive Black men who have sex with women only, with men only, or with men and women to assess differences among and between these groups. METHODS: We analyzed cross-sectional data from the Supplement to HIV and AIDS Surveillance Project for 2038 HIV-positive Black men who reported being sexually active. We classified the participants by their reported sexual behaviors in the past year: intercourse with women (n = 1186), with men (n = 741), or with men and women (n = 111). RESULTS: Respondents whose sexual partners were both men and women reported more noninjection drug use, sexual exchange, and sexual partners than did the other 2 groups. Bisexual respondents were also more likely than were heterosexuals to report unprotected intercourse with a steady female partner and were more likely than were both other groups to report having steady partners of unknown HIV serostatus and using drugs during their last sexual episode. CONCLUSIONS: HIV-positive Black men with both male and female sexual partners engaged in more sexual and drug risk behaviors than did their heterosexual and homosexual peers. More information concerning the prevention needs of behaviorally bisexual HIV-positive Black men is needed.

[Resuscitation of newborn infants]. / Reanimation des Neugeborenen.

Although almost 10% of all newborn infants need some form of respiratory assistance after birth, only 1% will require more advanced forms of resuscitation. Because these rare events cannot always be anticipated, pediatricians and neonatologists may not be readily available and resuscitation will have to be performed by anesthesiologists. In recent years, international guidelines for neonatal resuscitation have been revised by the International Liaison Committee on Resuscitation (ILCOR), the American Academy of Pediatrics (AAP) and the American Heart Association (AHA), as well as the European Resuscitation Council (ERC). The revised guidelines describe a simplified resuscitation algorithm which emphasizes the central role of respiratory support and an increase in heart rate is judged to be the best marker for successful ventilation. In deliveries complicated by meconium-stained amniotic fluid, intrapartum suctioning of the oropharynx is no longer recommended and endotracheal suctioning is restricted to severely depressed babies. The new guidelines mention the use of the laryngeal mask airway (LMA) and CO(2) detectors without, however, making firm recommendations. The use of 100% oxygen in neonatal resuscitation is increasingly being challenged. In the rare event of a newborn whose heart rate drops below 60 beats/min, more advanced resuscitation (chest compressions using the 2-thumb-encircling-hands technique, epinephrine 10-30 mug/kgBW i.v.) will be required. Finally, the guidelines mention the possible neuroprotective effect of therapeutic hypothermia after asphyxia, but finally only recommend that hyperthermia should be avoided.

Correlates of risk patterns and race/ethnicity among HIV-positive men who have sex with men.

Behaviors related to HIV infection vary by race, with African American and Latino men who have sex with men (MSM) more likely to report sex with women than are European-American MSM. The epidemic among African Americans, in particular, is growing rapidly among both men and women. Some have hypothesized that bisexually active men may be contributing to the epidemic among women. However, little is known about risk patterns among men of different races who are already infected. In this study of 456 HIV-seropositive MSM we found that, like HIV-negative MSM, African American MSM who are HIV-positive were less likely than European American men to identify as gay, more likely to report sex with women, and less comfortable discussing their MSM behavior with close friends and acquaintances. African American participants also exhibited higher levels of internalized homophobia, as well as lower self-efficacy for disclosing their HIV status to sex partners. Implications for interventions for this population are discussed.

Fine needle aspiration cytology as an adjunct to core biopsy in the assessment of symptomatic breast carcinoma.

INTRODUCTION: Core biopsy (CB) has now largely replaced fine needle aspiration cytology (FNAC) in the pre-operative assessment of breast cancer. We studied the contribution of FNAC, when done as an adjunct to CB, in cancer patients presenting symptomatically. PATIENTS: 112 patients had both CB and FNAC pre-operatively and subsequently had surgery (wide local excision or mastectomy). CB & FNAC were done clinically in half the patients and under ultrasound guidance in the majority of others. RESULTS: The complete sensitivity of FNAC was 90% and that of CB was 99%. Absolute sensitivity was 67% and 94%, respectively. CB was not suspicious of malignancy (B1) only in 1 patient in whom FNAC was suspicious (C3). In this patient there was a high degree of suspicion of breast cancer clinically & radiologically so a negative CB would not have been accepted even in the absence of FNAC. CONCLUSIONS: FNAC, when performed in addition to CB, does not provide useful additional information in symptomatic breast cancer patients.

Bactofection of mammalian cells by Listeria monocytogenes: improvement and mechanism of DNA delivery.

Bacteria-mediated transfer of plasmid DNA into mammalian cells (bactofection) is a potent approach to express plasmid-encoded heterologous proteins (protein antigens, toxins or enzymes) in a large set of different cell types including phagocytic and nonphagocytic mammalian cells. Previously, we have described a Listeria monocytogenes-mediated DNA delivery system, which releases plasmid DNA directly into the cytosol of mammalian cells by partial self-destruction of the carrier bacteria. Here we report on a second generation of this phage lysin supported bactofection system, which is greatly improved with respect to plasmid stability, transfer efficacy and biosafety. In this case, DNA release is initiated by spontaneous bacterial lysis in the infected cells cytosol which is subsequently enhanced by the simultaneously released phage lysin produced by the intracellular carrier bacteria. Bacteria that are capable of cell-to-cell spread are found to be much more efficient in bactofection than their non spreading counterparts.

Antibodies against listerial protein 60 act as an opsonin for phagocytosis of Listeria monocytogenes by human dendritic cells.

Human-monocyte-derived dendritic cells (MoDC) are very efficient in the uptake of Listeria monocytogenes, a gram-positive bacterium which is an important pathogen in humans and animals causing systemic infections with symptoms such as septicemia and meningitis. In this work, we analyzed the influence of blood plasma on the internalization of L. monocytogenes into human MoDC and compared the uptake of L. monocytogenes with that of Salmonella enterica serovar Typhimurium and Yersinia enterocolitica. While human plasma did not significantly influence the uptake of serovar Typhimurium and Y. enterocolitica by human MoDC, the efficiency of the uptake of L. monocytogenes by these phagocytes was strongly enhanced by human plasma. In plasma-free medium the internalization of L. monocytogenes was very low, whereas the addition of pooled human immunoglobulins resulted in the internalization of these bacteria to a degree comparable to the highly efficient uptake observed with human plasma. All human plasma tested contained antibodies against the 60-kDa extracellular protein of L. monocytogenes (p60), and anti-p60 antibodies were also found in the commercially available pooled immunoglobulins. Strikingly, in contrast to L. monocytogenes wild type, an iap deletion mutant (totally deficient in p60) showed only a minor difference in the uptake by human MoDC in the presence or the absence of human plasma. These results support the assumption that antibodies against the listerial p60 protein may play an important role in Fc-receptor-mediated uptake of L. monocytogenes by human MoDC via opsonization of the bacteria. This process may have a major impact in preventing systemic infection in L. monocytogenes in immunocompetent humans.

The use of harmonic analysis of the strain response in Pb(Mg(1/3)Nb(2/3)) O3-based ceramics to calculate electrostrictive coefficients.

The electromechanical response of ceramics has long been described with Landau Devonshire phenomenology, wherein the strain response is linked to a polynomial expansion in electric field or dielectric displacement. Consequently, the electromechanical response has been modeled with a variety of basis functions. However, these models have failed to accommodate hysteresis and the harmonic response that arises with saturation phenomena. In addition, no quantitative criterion has been used to truncate the expansion. By implementing a discrete Fourier transform in conjunction with Devonshire phenomenology, these three problems can be overcome as demonstrated with a dielectrically aged, lead magnesium niobate relaxor ferroelectric well above its Tmax, i.e., operating in the electrostrictive regime.

Electrostrictive ceramics for low-frequency active transducers.

Electrostrictive ceramics based on Pb(Mg(1/3)Nb(2/3 ))O(3) have demonstrated promise as low-frequency active materials. They broaden the range of design options by providing a mix of properties unavailable in traditional piezoceramics. Typical properties are: 1000 microstrain on the interval 0-1 MV/m with a k(33) of 0.5; high-field electrical impedance ~5 times that of traditional piezoelectrics; graceful, predictable, and repeatable property variation with temperature, frequency, and prestress; recoverable change of properties with temperature. Unipolar excitation at fields less than 1 MV/m is typical to provide direct frequency conversion and prevent corona discharge and reliability issues within transducers. Although electrostrictive ceramics are not direct replacements for traditional piezoceramics, they have many similarities in physical and chemical properties. The differences are most obvious in the electromechanical response behavior with changes in bias field, drive level, frequency, and prestress. In addition, the "rules-of-thumb" for traditional piezoceramics, both processing and use, do not wholly apply to electrostrictive ceramics. The development and present state of the art in electrostrictive ceramics for low-frequency uses are detailed.

Determination of nonlinear electromechanical energy conversion and the field-dependent elastic modulus of Pb(Mg(1/3)Nb(2/3 ))O(3)-based electrostrictors.

Energy conversion efficiency is a critical parameter for all electromechanical materials. Although excellent techniques are available for linear materials, nonlinearities complicate the determination of conversion efficiency in electrostrictive Pb(Mg(1/3)Nb(2/3 ))O(3) (PMN). The field dependence of the elastic modulus presents additional problems. A technique combining pulse-echo ultrasound has been developed to approximate the change in the Young's modulus with applied field. A 30% decrease was observed at 1 MV/m (from ~100 to ~70 GPa). The boundary condition for these measurements was a constant electric field as opposed to constant dielectric displacement. In combination with the results from harmonic analysis, the modulus data may be used to determine the electromechanical conversion efficiency. This has been accomplished using an energy balance criterion for a PMN-based composition (with and without dc bias). The resulting longitudinal coupling values are >0.5 for practical electric fields (<1 MV/m peak).

[Scintigraphic assessment of function in renal dystopia]. / Szintigraphische Funktionsberechnung bei renaler Lageanomalie.

In patients with renal dystopia radionuclide urography in commonly used technique may yield inaccurate results concerning split renal function. In a case of unilateral pelvic kidney a simple strategy to avoid this methodical error is demonstrated.

Harmonic analysis of the polarization response in Pb(Mg(1/3 )Nb(2/3))O(3)-based ceramics-A study in aging.

The polarization response of a ferroelectric ceramic displays nonlinear behavior at high applied fields due to saturation effects. Weak-field dielectric aging imposes additional nonlinearity on the hysteresis loops of these materials. Harmonic analysis using a discrete Fourier transform (DFT) permitted an observation of the change in the polarization frequency spectrum as Pb(Mg(1/3)Nb(2/3))O (3)-based relaxor ceramics aged. It also facilitated the calculation of ac current, power, and "internal bias field". The results show that particular harmonics in the polarization signal are sensitive indications of aging behavior. The average power dissipated at weak ac fields was found to decrease with aging time; and the power dissipated at strong fields tended to increase.